Now, the choice is getting easier for some patients.
On Sunday, within hours of the trial results being presented at American Society of Clinical Oncology (ASCO) 2018 meeting in Chicago, the 48-year-old emailed them to her doctor with this line: "This is good news for me".
'I'm delighted. I've been anxious for a long time about unnecessary treatment for cancer, and unnecessary side effects from chemotherapy, ' Dr. Otis Brawley, the chief medical and scientific officer for the American Cancer Society who was not part of the study, said.
The treatment, which succeeded after all other conventional treatments had failed, marks the first successful application of T-cell immunotherapy for late-stage breast cancer.
Thousands of women have been tested over the years using Oncotype DX to help determine the true effectiveness of chemo.
There was some benefit from the chemotherapy for a small subgroup - women with a score of 16 to 25 who were age 50 or younger, Sparano's team said. This left a lot of women, an estimated 65,000 in the US each year, in a gray zone, unsure if they would benefit from chemo.
St Vincent's University Hospital in Dublin had the second highest number of participating patients from the 1,182 research units involved.
A trial of more than 10,000 women - including 690 Irish women - with the most common form of early breast cancer found the treatment was unnecessary for many after surgery. Simply put, the side effects are awful: In addition to nausea, vomiting, hair and weight loss, chemo drugs can damage the heart and nervous system, and in rare cases, even cause different types of cancer.
The current study focused on those whose scores were in the middle range, from 11 to 25. Or was it sufficient for them to be treated only with endocrine therapy, which blocks the cancer-spurring properties of hormones?
Then, five and nine years later, the researchers checked in on how the women were doing.
More than 60,000 women a year in the USA could be affected, according to a lead researcher Dr. Joseph A. Sparano of Montefiore Medical Center in NY, and 70 percent of patients who would be potential candidates for chemo could be spared.
While the new study fills in a crucial gap of medical knowledge, what remains confusing is what took so long to get the point where we can measure twice and cut once, so to speak.
The CRCWM is primarily funded by the National Cancer Institute and has between 100 to 150 trials open at any time.
The cancer had spread to various parts of her body, including the liver.
The TAILORx trial used the Oncotype DX test, now available on the NHS, which allows doctors to predict the likelihood of the breast cancer returning.
Yet the move away from chemotherapy has been hotly debated, with some doctors warning that chemo can save lives and that a "de-escalation" of treatment could be unsafe. "The era of one- size-fits-all is basically coming to an end, which is great news".
After tumor removal, genetic testing is commonly used to predict which type of chemotherapy would give the most benefit.
The Oncotype DX test costs $4,600 and is typically reimbursed by insurance, according to Dr. Steven Shak, chief medical officer of Genomic Health, the maker of Oncotype DX.
"With this test, you listen to the tumor's genes", he said. After 42 weeks of tests, Perkins was completely cancer free and has remained so ever since. She enrolled in the TailorX trial and was relieved to be randomly assigned to the group that did not get chemotherapy.
"Oncologists have been getting much smarter about dialing back treatment so that it doesn't do more harm than good", said Steven Katz, a University of MI researcher who examines medical decision-making.
Brawley noted that the reduction in chemotherapy might reduce revenues for some oncologists, but he doesn't think they'll care.